When Your Physician Career Doesn’t Go as Planned (Because It Won’t)

Today’s guest post is a reflection from an early-career physician anesthesiologist whose career has been pretty typical.

You may think his career has been rather atypical until you realize that a story like this is closer to the norm than the exception. I’ve read that between one half and two thirds of physicians leave their first “permanent” position in the first few years after residency.

I didn’t realize it at the time that I penned it, but when I came up with the headline, I was clearly channeling another Doctor who goes by the name of Suess. From Oh, the Places You’ll Go!:

You’ll be on your way up! You’ll be seeing great sights! You’ll join the high fliers who soar to high heights.

You won’t lag behind, because you’ll have the speed. You’ll pass the whole gang and you’ll soon take the lead. Wherever you fly, you’ll be best of the best. Wherever you go, you will top all the rest.

Except when you don’t. Because, sometimes, you won’t.

When Your Physician Career Doesn’t Go as Planned (Because It Won’t)

I’m a 35-year old Physician Anesthesiologist, and my life and career just haven’t quite turned out how I expected.

I became interested in medicine, as many of us do, through personal experience. After a nearly year-long bout with a chronic Strep infection as a child, and requiring corrective orthopedic surgery as a teen, I knew that I wanted to dedicate my life to helping people live healthier lives.

I entered medical school in 2004, intent on a career in orthopedics. During the first month of anatomy lab, I came to the realization that I didn’t really enjoy the smell, texture, or taste of sawing through bone. [PoF: We were specifically instructed not to taste the bone.]

During my second year, I developed a love for cardiovascular physiology and entered my third year aiming for a career in cardiology, or even cardio-thoracic surgery. It turned out that all the general surgery residents I met were miserable, and I hated nothing more than going to clinic. So, as you may have guessed, I became an anesthesiologist.

I matched to a good out-of-state residency in 2008, and couldn’t be more happy with the career I chose.

Residency and an Awakening

Starting residency at the beginning of the Great Recession proved pivotal in our financial lives. My wife and I married while I was in med school, and knew essentially nothing about money until we felt the pressures of parental responsibility after our first daughter was born. We recognized the spending habits we’d had in our early twenties weren’t going to provide for much financial stability.

During those years of national economic difficulty, a new collective consciousness seemed to arise among professionals, which placed value on financial responsibility over consumer spending. An awareness that keeping up with the Joneses and living a lifestyle of entitlement had severely handicapped the previous generation of physicians.

That awakening, combined with our limited resident salaries, forced us to reprioritize our lackluster spending habits and live life with a financial plan. We learned to only spend money on things that added actual value to our lives and to ignore the societal pressures to dress a certain way, drive a certain vehicle, and meet certain lifestyle expectations.

During residency, our family grew from three to four. After doing some figuring, we realized that the amount of money my wife could earn would pay for childcare and not much else. For us, there was tremendously more value to her staying home with our babies, than for her to work just to pay someone else to raise the kids.

In 2010, I was diagnosed with autoimmune kidney disease. This new life challenge placed an even greater emphasis on responsible financial management. My health has been stable since the diagnosis, but there’s nothing quite like the possibility of losing one’s income potential to change one’s approach to life and finances.

As my residency career advanced, the number of available jobs and starting salaries seemed to decrease annually. Older physicians, who had taken a hit during the recession, just weren’t giving up their jobs, and existing groups were trying to conserve capital in the face of downward pressure on physician reimbursement.

My wife and I knew we wanted to move back to Central Texas to be closer to my family and because of the very reasonable cost of living. But, it turned out that Central Texas was one of the areas that seemed to be less hard-hit by the recession, so everyone else wanted to move there, as well.

The First “Permanent” Attending Position

My first job out of residency was in a rural community just outside of Dallas. My wife and our two kids started saving like crazy. We recognized the trend towards decreasing physician salaries, and we wanted to maximize the benefit of my income. We paid off my $128k of student loans in a year and a half, built an emergency fund of six months of expenses, bought a minivan, and welcomed our third and final kiddo into our family.

I enjoyed the group I worked for. We served a wonderful, albeit challenging, rural patient population. Our group employed 28 nurse anesthetists and anesthesia assistants. I stepped in and managed their vacation scheduling, sick day requests, and other personnel issues, resulting in an uptick in overall employee satisfaction.

Our busy practice, however, left me feeling a little disappointed. I spent the majority of my days doing histories and physicals and very little time actually caring for patients. After working for about a year, a national company came in and bought the group that I worked for.

Suddenly, my ability to become a partner changed. Because of my pre-partner track, I did not benefit from “buyout” money that our senior partners received, and my track to partnership became muddled with conflicting promises that never did quite find their way onto paper. I realized newly increased buy-in costs, delayed years to buy-in, and a net decrease in attending salaries would cost me nearly a million dollars over the next three years.

The Second “Permanent” Attending Position

So, I became one of the nearly 70% of physicians who leave their first job in the first two years. A job opened up about an hour from where my parents live, in a physician-only group. We seized the opportunity and moved about three months later.

My wife and I purchased our first home and finally replaced the car I was driving, a car my wife had owned since college. I have been happily settled at my current place of employment for nearly four years. I became partner this last summer, and am currently serving as the anesthesiology chief at one of our local hospitals.

During that period of time, our home, which had been renovated prior to purchase, developed a leaky roof that couldn’t seem to be fixed, despite having the entire thing replaced. It also had a number of high-end finishes that simply weren’t intended to be used by small children.

they look so innocent… maybe not the little one

Then our kids got bigger, and the house’s layout became suddenly challenging. We determined we could live in it for another five or six years, but then the cost for needed replacements would be higher than what it would cost to sell early and buy something newly built.

So, we sold our first home and started building a higher-end tract home, on a beautiful lot in a nearby neighborhood. But after several months of the builder making floor plan changes, changes to the exterior stone color, and ignoring essentially every custom selection we had asked and paid for, we had our doubts. Sounds like fun, right?

We bailed. We were able to find a house in a phenomenal neighborhood, and after a little DIY elbow grease, it’s a perfect fit for our family.

Finally, over this last year, our large group has taken a pay cut as local hospitals (under national pressure) have stopped paying certain guaranteed revenues that had previously covered under-insured patients.

That’s quite the adventure, huh?? I love my career in medicine, but there seems to be an alternative plan to the quite predictable life that I envisioned in my premed and medical school years.

So, how do/did we deal with all of the changes?? We developed some skills that allow us to adapt to life’s shifting norms.

Lessons From My First Five Years as an Attending Physician

1. Have a plan!

We only get one shot at this thing called life, so decide what kind of life you want to have. Then figure out how your finances best line up with that. For me, receiving an auto-immune diagnosis has made it easier to say “no” to certain luxuries, and to make sure we are storing adequate financial reserves for our future.

I’ve also realized, I may not want to do medicine full time till I’m 65. As much fun as I’ve had sacrificing nights, weekends, and holidays, I would so much rather spend those with my family and friends. On our current trajectory, we should be FI in under 10 years. Once we’ve reached FI, I don’t know that I’ll give up clinical medicine entirely, but I would love to dedicate some of my time to other meaningful interests in my life.

2. Be flexible!

Life changes. Your plans shouldn’t be so etched in stone, that they can’t survive a few surprises. When you face a major life change, take the time to redevelop your life plan to meet the new changes, and ADAPT. Not all change is bad!!

3. Live within your means.

It’s so tempting, when finishing residency, to buy that big house or that luxury car or status symbol. We chose to rent modest dwellings during medical school and residency even though many of our friends bought. After comparing notes at graduation, we actually came out ahead on housing costs. In our case, there was the recession to consider, but I’m not sure the results would have been considerably different given today’s real estate trends.

As Americans and professionals, many of us have ideas of things we “need,” and some of us may have even had financial motivations to select our field of expertise. A great question to ask yourself is, “Does this purchase/experience enhance or otherwise add value my life?”.

In the times where it does, and you can afford it, do it. For me, I have a yard that’s about an acre, and I choose to have a landscaping company mow it. For $50 I can have someone come and do 3 hours worth of work, freeing me up to spend that time with the family. My son, who is eight, has expressed interest in learning how to mow. Later this year, it may provide him a good opportunity to “earn a living”.

4. Save

My wife and I made a habit of saving, even in residency. After funding an emergency account, most of our money went into a Roth IRA, and it is still the account that I have the most sentimental value for, even if it’s not the most valuable. Saving during those leaner times meant that we had to sacrifice some conveniences, but I can’t seem to really remember what those were.

No Annual Fee, a $500 welcome bonus with $3k spent in 3 mo. & up to 5% cash back on certain purchases. More on why it's one of my favorite cash back business cards here.

Our personal post-residency savings rate has never been less than 50% of our net income. We max out all of our tax-deductible accounts first, then invest the remainder in a taxable account and the kids 529’s. We accomplish this by choosing a low cost of living area and by making active choices about what we spend our money on.

Saving the first million dollars is really not a lot of fun. The first half was great! Every dollar that you sock away increases your account value significantly, but somehow, after you pass the halfway mark, it seems like the balance gets STUCK at one particular place, and never advances. Stick with it!!

Most of the financial books and blogs you read say the first million is the hardest. We should reach that milestone by the end of the year. Here’s hoping!!

5. Give

I know there are lots of opinions out there about this one. We have always made it a point to give a minimum of 10% of our gross income each year. Some of that money we’ve given to our church or local organizations that build and serve our community, and to individuals that we know facing unexpected emergencies.

Last year, we helped some friends with unexpected legal costs involving custody of their daughter. Having been given so much in life, we feel the privilege, and responsibility, to care for those around us and to share what we have with others.

[PoF: I like to encourage giving to and from a donor advised fund to get the most bang for your donated buck.

Related Posts from Physician on FIRE

6. Life isn’t all about money.

This year I celebrate my 5th year in private practice, and I am beginning to develop some new perspectives on life. I enjoy taking care of my patients. I enjoy group administrative activities.

But, sometimes I sometimes feel stunted, and that being a physician leaves a few of my buttons un-pushed. Like many physicians, spouses, and parents who may have sacrificed for the “plan”, I’m in the process of re-discovering some buttons that I’ve completely forgotten over the years.

In the end, it’s not about whether or not your portfolio allows you to remove 4% annually, and still leave you with something to pass on to the next generation. It’s about what you make of this life and the opportunities that you are given every day. Find the thing that makes you excited, that once-in-a-lifetime memory, that purpose that will define you, and LIVE IT!

38 comments

You are definitely ahead of the game despite the circuitous path you took. You made some financially prudent choices (unlike me) early on in your career and now have set yourself up for financial success later. I fell into the I need to buy a house (actually bought 2 DURING my residencies), fell victim to needing to buy a luxury car BEFORE becoming an attending, and all sorts of mistakes beyond that that has handicapped my path to financial success (but did not make it impossible as at 47 I feel I am now way ahead of the game thanks to finally seeing the light about 6 years ago). Congratulations for prioritizing time over money. Most don’t get to that realization of what’s truly important until it’s too late (kids grown etc). I still mow my own lawn. I could definitely afford to have someone do it for me (I maintain about 2 acres of a 7.6 acre property) but it actually is an enjoyable event and keeps me in tune with my yard. Best of luck continuing your career path.

I unfortunately didn’t avoid making ANY mistakes with housing, but it could have been worse. I attribute the majority of my success to marrying well (a woman who is just as/More passionate about fiscal responsibility as I am).

You probably hit the key to the most important component of financial success. If I married well (I didn’t) I would be so far ahead of the financial game right now they I think I probably could have fat Fired by now. Read my post next Tues on my blog if you want truly want to see what kind of financial impact I am talking about)

Thanks for sharing your experiences. You seem to be on the right path and clearly possess the WCI “X-factor”.

I changed jobs at the end of my second year in PP, moved across the country, and, in a very unusual twist, returned back to the original job short of 6 months later (the grass wasn’t greener!) and have stayed now going on 20 years.

Thanks for the article, what are some of the un-pushed buttons you mentioned. I have some hobbies like woodworking that I would love to eventually do “full time” at some point. It gives me motivation to continue to save at a high rate.

Sounds like fun things to strive for. I know the stats for new restaurants are not overwhelmingly positive, but if you are FI with a plan to fall back on why not follow your passions and interests. That’s the whole point of FI! Thanks for sharing your story

In many ways your work life trajectory mirrors mine. We are both 35 years old. And we are both 5 years into being an attending. Therefore, just like you… I started residency at the nadir of the financial crisis and great recession of 2008. I share a glimpse of my experience here. And just like you, I lived far below my means too. And like you… I’m somewhere near a million net worth mark if you count the appreciation of my house and I will be complete FI in 6-10 years.

You have me beat in the kids department though. I’m playing catch up and only have one so far. And she’s only 7 weeks old! 🙂

Anyways, I totally agree with all of the lessons you described in your first five years of being an attending because I can totally relate; I learned the same lessons and employ the same techniques too.

It’s great to hear from another physician who is in the exact same stage in their career. Thank you for sharing your story.

It’s always great to learn you’re not the only one, right?? Our path to parenthood happened a solid 5 years before we had anticipated, but having kids that can wipe their own butts, feed themselves, and sleep through (most) nights is kind of my favorite life stage. I’m currently teaching them all how to play poker! It’s great!

I loved this article! Thanks for posting it. Though I stayed with my first job after finishing my residencies, life happened. I was diagnosed with metastatic cancer just before starting, and didn’t think I would live more than 5 years. That was in 1991! That changed my perspective, though, so when I found myself stressed, unhappy, and never home to be there for our grade school/ middle school kids or my husband, I retired at 47. I was grateful we had saved; we learned to really rein in our expenses, and enjoy a real life of meaning. I fell into health coaching several years after just being home with the kids and never went back. My husband left his practice the next year to join me in the business. I think living under one’s means and focusing on what matters most is a key to fulfillment. You sound like you are doing a great job at figuring that out early. All the best!

I wonder if the problem is the characterization of the plan. Medicine is not a stable business anymore but then from what I’ve read a third to 40% of the jobs are going to gig players.

One thing I think is helpful is to characterize your retirement as the purchase of a “future security product” like paying off your mortgage is purchasing your house product. Let’s say your house is costing 5K per month, 60K per year. Lets say your retirement is costing 10K per month 120K per year, suddenly your $300K salary isn’t that big. I think this point of view helps in planning, and it allows you to readily understand if you can really afford 10K per month. Maybe you need to cut back to 8k and work a little longer. If you look at your retirement as the purchase of a future security product and not as net worth, the perspective on FI also changes. You no longer think in terms of FI but in terms of adequate future security. It takes a long time to adequately plan and fund a future security product. I’m now living comfortably off my “security product” It didn’t occur to me to think about things like this till a couple years ago, but I find it very useful. If your security product holds 3M in value, what are you going to do if it breaks down? One thing is a side gig, another might be to pick up some work at Walmart, or stash away an extra $500K. In 20 years 500K becomes 1.6M with no additional added money. If your plan was a 30 year horizon and SORR killed your 3M at 20years you have 1.6M sitting in portfolio insurance.

This post resonated with me and my career path. I’m going into my 21st year as a surgical sub-specialist, and I placed too much stock into thinking that I was going to stay in my first job (academic) for 20+ years. That was 3 jobs ago. My family and I moved across the country after 3 and 1/2 years, joining a private practice group where I was miserable. That lasted 9 months. I started my own group, and was very happy. Then, I got recruited back to academic surgery, and I’ve been here for 13 years.

I counsel my residents that the terms of separation are just as important as the terms of employment. Don’t get stuck paying the tail on your malpractice, when you can negotiate that away. I also tell them to hold off buying the big doctor house when they first start a job (like I did). They still do it anyway.

This is a great post and definitely shows what it’s “really like.” My parents are both physicians and had a private practice in south Louisiana for 20 years. Then, Hurricane Katrina hit and they lost their business overnight. They moved to a different city, my mom got hired part time by a large group and my dad went to work in a more academic setting. I don’t think either one of them thought this is where they’d be and the hurricane = loss of house and loss of business put tremendous financial strain on them. Now that I’m married to a physician, I definitely am more of the mindset to expect the unexpected. We always dream of having a place to finally settle down but we also agree that it might not be where we think at all.

I should have been a specialist. I get jealous when I see all these specialist FI folks who already have 1M just 5 years out of residency [I’m 5 years out now too]. Despite a very modest lifestyle and home there is no way I could be at 1M right now and I’ve been contributing to a ROTH since 18yo! Oh well – we will get there eventually! I stuck with my first place of practice and have been a shareholder for a few months now so we will just keep plugging along and building up those accounts. The great divide between primary care and specialists does exist. I know we all work hard but it can get disheartening at times… I’m trying not to complain too much in this post — do I sound whiny? 😉

Yeah, specialty choice definitely has made a huge impact, but you have to do what you love. Also, as you can tell our journey has been far from smooth 😉. Hang in there, and set realistic goals. It seems that time and perseverance are what counts the most! (And I too started a Roth at 18🎉)

I would like to give several important pieces of information for a physician’s first job. 1) Don’t get stuck with paying your malpractice tail. You can usually negotiate it out of the contract. If you are required to pay the tail, find out the cost if you stay the length of the contract. 2) Don’t buy the big luxury “doctor house” . Wait at least 6 months. Things to keep in mind. Building a house from the ground up is not always a plus. If you have no knowledge as a contractor, how do you know if the builder is using short cuts? If you buy a luxury home in a small community and you decide to move, who can afford to buy from you? 3) Becoming a partner in a medical practice increases your total liability. If an employee sues for sexual harassment, as a partner you are responsible for legal and settlement costs. It is not covered by malpractice insurance. 4) Don’t start a job trying to be the “hot shot” or “know it all” 5) Read your contract well. Many have a clause that you can be terminated without cause. 6) Remember it is not how much money you make…. it is how much you get to keep in reaching FI. Start financial planning early. Start off reducing spending in residency. 7) Carry your own disability insurance. Don’t depend on the job to take care of you ! 8) If you have children examine the educational system in the community. 9) I have always tried to live less than 1 1/2 hours from a major airport. Living near a major airport reduces travel costs.

Really good post. I am sorry I missed it until now. I hope your renal problem is stable. I think the combo of a health issue plus the Great Recession cemented into your psyche some important life lessons.

So much truth here about the need for flexibility. But my favorite is your comment about your wife. I’m not a doc (just married to one) and being united on finances is a game changer. We’ve moved, had kids and health issues too. I guess, that means we are living! Best to you and your family.

Thanks for sharing your experiences. Everyone’s path to wealth is so different and I enjoy hearing personal stories like yours. Life throws curve balls at us all the time so being adaptable and resilient are important traits to have.